Associations of MRI-Derived Glymphatic System Impairment With Global White Matter Damage and Cognitive Impairment in Mild Traumatic Brain Injury: A DTI-ALPS Study.

BACKGROUND: Assessing the glymphatic function using diffusion tensor image analysis along the perivascular space (DTI-ALPS) may be helpful for mild traumatic brain injury (mTBI) management. PURPOSE: To assess glymphatic function using DTI-ALPS and its associations with global white matter damage and cognitive impairment in mTBI. STUDY TYPE: Prospective. POPULATION: Thirty-four controls (44.1% female, mean age 49.2 years) and 58 mTBI subjects (43.1% female, mean age 48.7 years), including uncomplicated mTBI (N = 32) and complicated mTBI (N = 26). FIELD STRENGTH/SEQUENCE: 3-T, single-shot echo-planar imaging sequence. ASSESSMENT: Magnetic resonance imaging (MRI) was done within 1 month since injury. DTI-ALPS was performed to assess glymphatic function, and peak width of skeletonized mean diffusivity (PSMD) was used to assess global white matter damage. Cognitive tests included Auditory Verbal Learning Test and Digit Span Test (forward and backward). STATISTICAL TESTS: Neuroimaging findings comparisons were done between mTBI and control groups. Partial correlation and multivariable linear regression assessed the associations between DTI-ALPS, PSMD, and cognitive impairment. Mediation effects of PSMD on the relationship between DTI-ALPS and cognitive impairment were explored. P-value <0.05 was considered statistically significant, except for cognitive correlational analyses with a Bonferroni-corrected P-value set at 0.05/3 ≈ 0.017. RESULTS: mTBI showed lower DTI-ALPS and higher PSMD, especially in complicated mTBI. DTI-ALPS was significantly correlated with verbal memory (r = 0.566), attention abilities (r = 0.792), executive function (r = 0.618), and PSMD (r = -0.533). DTI-ALPS was associated with verbal memory (ß = 8.77, 95% confidence interval [CI] 5.00, 12.54), attention abilities (ß = 5.67, 95% CI 4.56, 6.97), executive function (ß = 2.34, 95% CI 1.49, 3.20), and PSMD (ß = -0.79, 95% CI -1.15, -0.43). PSMD mediated 46.29%, 20.46%, and 24.36% of the effects for the relationship between DTI-ALPS and verbal memory, attention abilities, and executive function. DATA CONCLUSION: Glymphatic function may be impaired in mTBI reflected by DTI-ALPS. Glymphatic dysfunction may cause cognitive impairment related to global white matter damage after mTBI. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

Application of color doppler ultrasound and US shear wave elastography with connective tissue growth factor in the risk assessment of papillary thyroid carcinoma.

BACKGROUND: This study aims to investigate the role of shear wave elastography (SWE) and connective tissue growth factor (CTGF) in the assessment of papillary thyroid carcinoma (PTC) prognosis. METHODS: CTGF expression was detected with immunohistochemistry. Clinical and pathological data were collected. Parameters of conventional ultrasound combined with SWE were also collected. The relationship among CTGF expression, ultrasound indicators, the elastic modulus and the clinicopathological parameters were analyzed. RESULTS: Univariate analysis showed that patients with high risk of PTC were characterized with male, Uygur ethnicity, increased expression of CTGF, convex lesions, calcified, incomplete capsule, intranodular blood flow, rear echo attenuation, cervical lymph node metastasis, lesions larger than 1 cm, psammoma bodies, advanced clinical stage, increased TSH and high value in the shear modulus (P < 0.05). Multivariate analysis demonstrated that the risk factors of high expression of CTGF according to contribution size order were irregular shape, aspect ratio ≥ 1, and increased TSH. The logistic regression model equation was Logit (P) = 1.153 + 1.055 × 1 + 0.926 × 2 + 1.190 × 3 and the Area Under Curve value of the logistic regression was calculated to be 0.850, with a 95% confidence interval of 0.817 to 0.883. CONCLUSION: SWE and CTGF are of great value in the risk assessment of PTC. The degree of fibrosis of PTC is closely related to the prognosis. The hardness of PTC lesions and the expression level of CTGF are correlated with the main indexes of conventional ultrasound differentiating benign or malignant nodules. Irregular shape, aspect ratio ≥ 1, and increased TSH are independent factors of CTGF.

A comparative review of the application value of FAPI PET/CT and 18F-FDG PET/CT in lung cancer.

Fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) is a multimodal imaging technique that combines PET and CT, utilizing FAP inhibitors as radiotracers. Fibroblast activation protein, a serine protease highly expressed in many epithelial tumor-associated fibroblasts, plays a crucial role in tumor stroma formation and remodeling. Through the detection of FAP expression, FAPI PET/CT facilitates the diagnosis and staging of both benign and malignant pulmonary tumors. In contrast to traditional fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT focusing on glucose metabolism, FAPI PET/CT offers benefits such as enhanced specificity, reduced background noise, accelerated imaging speed, and decreased radiation exposure. This review provides an overview of the progress in applying FAPI PET/CT and 18F-FDG PET/CT in pulmonary malignancies and discusses current challenges and future prospects.

Diagnostic performance of diffusion-weighted imaging versus 18F-FDG PET/CT in differentiating pulmonary lesions: an updated meta-analysis of comparative studies.

OBJECTIVE: To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for differentiating pulmonary nodules and masses. METHODS: We systematically searched six databases, including PubMed, EMBASE, the Cochrane Library, and three Chinese databases, to identify studies that used both DWI and PET/CT to differentiate pulmonary nodules. The diagnostic performance of DWI and PET/CT was compared and pooled sensitivity and specificity were calculated along with 95% confidence intervals (CIs). The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the quality of the included studies, and STATA 16.0 software was utilized to perform statistical analysis. RESULTS: Overall, 10 studies that enrolled a total of 871 patients with 948 pulmonary nodules were included in this meta-analysis. DWI had greater pooled sensitivity (0.85 [95% CI 0.77-0.90]) and specificity (0.91 [95% CI 0.82-0.96]) than PET/CT (sensitivity, 0.82 [95% CI 0.70-0.90]); specificity, (0.81, [95% CI 0.72-0.87]). The area under the curve of DWI and PET/CT were 0.94 (95% CI 0.91-0.96) and 0.87 (95% CI 0.84-0.90) (Z = 1.58, P > 0.05), respectively. The diagnostic odds ratio of DWI (54.46, [95% CI 17.98-164.99]) was superior to that of PET/CT (15.77, [95% CI 8.19-30.37]). The Deeks' funnel plot asymmetry test showed no publication bias. The Spearman correlation coefficient test revealed no significant threshold effect. Lesion diameter and reference standard could be potential causes for the heterogeneity of both DWI and PET/CT studies, and quantitative or semi-quantitative parameters used would be a potential source of bias for PET/CT studies. CONCLUSION: As a radiation-free technique, DWI may have similar performance compare with PET/CT in differentiating malignant pulmonary nodules or masses from benign ones.

Critical Role of Simultaneous Reduction of Atmospheric Odd Oxygen for Winter Haze Mitigation.

The lockdown due to COVID-19 created a rare opportunity to examine the nonlinear responses of secondary aerosols, which are formed through atmospheric oxidation of gaseous precursors, to intensive precursor emission reductions. Based on unique observational data sets from six supersites in eastern China during 2019-2021, we found that the lockdown caused considerable decreases (32-61%) in different secondary aerosol components in the study region because of similar-degree precursor reductions. However, due to insufficient combustion-related volatile organic compound (VOC) reduction, odd oxygen (Ox = O3 + NO2) concentration, an indicator of the extent of photochemical processing, showed little change and did not promote more decreases in secondary aerosols. We also found that the Chinese provinces and international cities that experienced reduced Ox during the lockdown usually gained a greater simultaneous PM2.5 decrease than other provinces and cities with an increased Ox. Therefore, we argue that strict VOC control in winter, which has been largely ignored so far, is critical in future policies to mitigate winter haze more efficiently by reducing Ox simultaneously.

Differentiating between malignant and benign solid solitary pulmonary lesions: are intravoxel incoherent motion and diffusion kurtosis imaging superior to conventional diffusion-weighted imaging?

OBJECTIVE: To quantitatively compare the diagnostic values of various diffusion parameters obtained from mono- and biexponential diffusion-weighted imaging (DWI) models and diffusion kurtosis imaging (DKI) in differentiating between benign and malignant solitary pulmonary lesions (SPLs). METHODS: Multiple b-value DWIs and DKIs were performed in 89 patients with SPL by using a 3-T magnetic resonance (MR) imaging unit. The apparent diffusion coefficient (ADC) of various b-value sets, true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), apparent diffusional kurtosis (Kapp), and kurtosis-corrected diffusion coefficient (Dapp) were calculated and compared between the malignant and benign groups using a Mann-Whitney U test. Receiver-operating characteristic analysis was performed for all parameters. RESULT: The ADC(0, 150) values of malignant tumors were lower than those of the benign group (p = 0.01). The ADC(0, 300), ADC(0, 500), ADC(0, 600), ADC(0, 800), ADC(0, 1000), ADCtotal, D, and Dapp of malignant tumors were significantly lower than those of benign lesions (all p < 0.001). D*, f, and Kapp showed no statistically significant differences between the two groups. ADCtotal showed the highest area under the curve (AUC = 0.862), followed by ADC(0, 800)(AUC = 0.844), ADC(0, 600)(AUC = 0.843), D(AUC = 0.834), ADC(0, 1000)(AUC = 0.834) and ADC(0, 500)(AUC = 0.824), Dapp(AUC = 0.796), and ADC(0, 300) (AUC = 0.773). However, the difference in diagnostic efficacy among these parameters was not statistically significant (p > 0.05). CONCLUSION: Intravoxel incoherent motion (IVIM) and DKI-derived parameters have similar performance compared with conventional ADC in differentiating SPLs. KEY POINTS: • Mono- and biexponential DWI and DKI are feasible for differentiating SPLs. • ADC (0, ≥500) has better performance than ADC (0, <500) in assessing SPLs. • IVIM and DKI have similar performance compared with conventional DWI in differentiating SPLs.

Evaluation of radiation-induced peripheral nerve injury in rabbits with MR neurography using diffusion tensor imaging and T2 measurements: Correlation with histological and functional changes.

PURPOSE: To investigate the potential of diffusion tensor imaging (DTI) and T2 measurements in the evaluation of radiation-induced peripheral nerve injury (RIPNI). MATERIALS AND METHODS: RIPNI was produced in a randomly selected side of sciatic nerve in each of 21 rabbits while the contralateral side served as the control. The limb function and MR parameters were evaluated over a 4-month period. Fractional anisotropy (FA), axial diffusivity (λ∥ ), radial diffusivity (λ⊥ ) and T2 values were obtained using 3T MR for quantitative analysis. Two animals were randomly killed for histological evaluation at each timepoint. RESULTS: The T2 value of irradiated nerve increased at 1 day (63.95 ± 15.60, P = 0.012) and was restored at 1 month (52.34 ± 5.38, P = 0.105). It increased progressively at 2 to 4 months (60.39 ± 10.60, 66.96 ± 6.08, 75.51 ± 7.39, all P < 0.01). λ⊥ significantly increased at 1 day (0.82 ± 0.44, P = 0.046) and slightly decreased at 1 month (0.61 ± 0.17, P < 0.001). It increased gradually from 2 to 3 months (0.84 ± 0.29, 1.13 ± 0.33, both P < 0.001) followed by a decline at 4 months (0.83 ± 0.17, P < 0.001). FA was statistically lower than the contralateral sides at 1 to 4 months (0.72 ± 0.08, 0.60 ± 0.12, 0.51 ± 0.11, 0.62 ± 0.06, all P < 0.01). Changes in FA and λ⊥ correlated well with the functional and pathological changes in irradiated nerve. CONCLUSION: DTI may be a more sensitive and accurate method to evaluate RIPNI compared with T2 measurements. FA and λ⊥ are promising quantitative indices in monitoring RIPNI. J. Magn. Reson. Imaging 2016;43:1492-1499.

Development of a Rabbit Model of Radiation-Induced Sciatic Nerve Injury: In Vivo Evaluation Using T2 Relaxation Time Measurements.

OBJECTIVES: To develop a rabbit model of radiation-induced sciatic nerve injury (RISNI), using computed tomography (CT)-guided stereotactic radiosurgery, and assess the value of T2 measurements of injured nerves. MATERIALS AND METHODS: Twenty New Zealand rabbits were randomly divided into A (n = 5) and B (n = 15) groups. Group A rabbits underwent CT and magnetic resonance scan and were then killed for comparison of images and anatomy of sciatic nerves. One side of the sciatic nerve of group B rabbits received irradiation doses of 35, 50, or 70 Gy (n = 5 per group). Magnetic resonance imaging and functional assessments were performed before irradiation and 1, 2, 3, and 4 months thereafter. RESULT: The thigh section of the sciatic nerve outside the pelvis could be observed by CT and magnetic resonance imaging. T2 values of the irradiated nerve of the 35-Gy group increased gradually, peaking at 4 months; T2 values of the 50-Gy group increased faster, peaking at 3 months. Significant differences between the 35-Gy and control groups were found at 3 and 4 months, and between the 50-Gy and control groups at 2, 3, and 4 months. Functional scores of the 50-Gy group declined progressively, whereas the 35-Gy group scores reached a low point at 3 months posttreatment and then recovered. Functional scores of the irradiated limbs demonstrated a negative correlation with T2 values (r = -0.591 and -0.595, P < 0.05). Electron microscopy revealed progressive deformation and degeneration of the irradiated nerve in the 35- and 50-Gy groups, which were more severe in the 50-Gy group. CONCLUSIONS: A rabbit RISNI model can be produced using the midthigh segment of the sciatic nerve and single-fraction doses of 35 and 50 Gy. Although T2 values are useful for monitoring RISNI, they may not be sensitive enough to evaluate its severity.

Value of (18)F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma.

Primary small cell carcinoma (SCC) is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma (ESCC) is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) findings. MRI showed that the uterus was significantly enlarged (11.6 cm × 11.1 cm × 14.4 cm), and a giant irregular mass (7.5 cm × 8.4 cm × 8.5 cm) was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient (ADC) value [(0.553±0.088)×10(-3) mm(2)/s] and a high FDG uptake value (22.7). Multiple metastatic lymph nodes (LNs) were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value (SUVmax) ranging from 6.9 to 19.3.

[Study on structure, charge and spectrum for para-halogenated diphenyl ethers through density functional theory].

The present paper mainly researched the molecular geometry, charge distribution and spectrum vibration of diphenyl ether and its 3 kinds of para-halogenated diphenyl ethers based on density functional theory (DFT). The infrared and Raman spectrum vibration frequency for para-halogenated diphenyl ethers was calculated based on respective optimal molecular geometry with the same method which was carried out at the B3LYP/6-31(d) level, then spectrum vibration of para-halogenated diphenyl ethers was assigned in detail for the first time. Combined with charge distribution of diphenyl ether and by the nuclear magnetic resonance and Milliken charge distribution, the authors also analyzed the effect of different para-halogenated substituent on charge distribution, at last the vibration mechanism and change rule of of para-halogenated diphenyl ethers' characteristic vibrations were analyzed in the view of charge distribution innovatively. From the research we can see that the more the electronegativity of para-halogenated substituent, the bigger the atomic radius, and the longer the C-X bond, the easier they are degraded in the environment; para-halogenated substituent affected the charge distribution greatly especially to para-carbon relative to ether bond, and meta-carbon was controlled by the combination electronic effect of para-halogenated substituent and oxygen atom, meanwhile ortho-carbon didn't have distinct change; charge gap between bond atoms played significant role in the stability of bonds and vibration frequency of characteristic vibration, and the larger the electronegativity of para-halogenated substituent, the larger the vibration frequency.

[Vibrational assignment analysis of Raman spectra of fatty alcohols].

In the present research, Raman spectra of 31 fatty alcohols were calculated by B3LYP/6-31G (d) and verified by taking methanol for example. The study results indicate that B3LYP/6-31G (d) is an effective approach for the fatty alcohols Raman spectra calculated. The vibrational assignment and Raman spectra features of 6 unbranched alcohols were discussed and the vibrating peaks derived from stretching vibration by C-O were chosen as the research target selection, and the multiple principal component regression models were established and validated with the parameters including polarizability, thermodynamic and energy parameters of the above unbranched alcohols. There exists significant correlation between the vibrating peaks derived from stretching vibration by C-O of fatty alcohols and the parameters (sig. = 0.015). This study will benefit the Raman spectra research of homologs.

Role of multiple dual-phase 18F-FDG PET/CT metabolic parameters in differentiating adenocarcinomas from squamous cell carcinomas of the lung.

Purpose: To evaluate the ability of multiple dual-phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters to distinguish the histological subtypes of non-small cell lung cancer (NSCLC). Methods: Data from 127 patients with non-small cell lung cancer who underwent preoperative dual-phase 18F-FDG PET/CT scanning at the PET-CT center of our hospital from December 2020 to October 2021 were collected, and the metabolic parameters of their primary lesions were measured and analyzed retrospectively. Intraclass correlation coefficients (ICC) were calculated for consistency between readers. Metabolic parameters in the early (SUVpeak, SUVmean, SUVmin, SUVmax, MTV, and TLG) and delayed phases (dpSUVpeak, dpSUVmean, dpSUVmin, dpSUVmax, dpMTV, and dpTLG) were calculated. We drew receiver operating characteristic (ROC) curves to compare the differences in different metabolic parameters between the adenocarcinoma (AC) and squamous cell carcinoma (SCC) groups and evaluated the ability of different metabolic parameters to distinguish AC from SCC. Results: Inter-reader agreement, as assessed by the intraclass correlation coefficient (ICC), was good (ICC = 0.71, 95% CI:0.60-0.79). The mean MTV, SUVmax, TLG, SUVpeak, SUVmean, dpSUVmax, dpTLG, dpSUVpeak, dpSUVmean, and dpSUVmin of the tumors were significantly higher in SCC lesions than in AC lesions (P = 0.049, < 0.001, 0.016, < 0.001, 0.001, < 0.001, 0.018, < 0.001, 0.001, and 0.001, respectively). The diagnostic efficacy of the metabolic parameters in 18F-FDG PET/CT for differentiating adenocarcinoma from squamous cell carcinoma ranged from high to low as follows: SUVpeak (AUC = 0.727), SUVmax (AUC = 0.708), dpSUVmax (AUC = 0.699), dpSUVpeak (AUC = 0.698), TLG (AUC = 0.695), and dpTLG (AUC = 0.692), SUVmean (AUC = 0.690), dpSUVmean (AUC = 0.687), dpSUVmin (AUC = 0.680), SUVmin (AUC = 0.676), and MTV (AUC = 0.657). Conclusions: Squamous cell carcinoma of the lung had higher mean MTV, SUVmax, TLG, SUVpeak, SUVmean, SUVmin, dpSUVpeak, dpSUVmean, dpSUVmin, dpSUVmax, and dpTLG than AC, which can be helpful tools in differentiating between the two. The metabolic parameters of the delayed phase (2 h after injection) 18F-FDG PET/CT did not improve the diagnostic efficacy in distinguishing lung AC from SCC. Conventional dual-phase 18F-FDG PET/CT is not recommended.

Pulmonary Sarcomatoid Carcinoma With Epiglottis and Ileum Metastasis Detected by 18F-FDG PET/CT.

ABSTRACT: Pulmonary sarcomatoid carcinoma is a rare subtype of non-small cell lung cancer with poor prognosis. It often metastasizes to lymph nodes, bone, adrenal gland, liver, and brain. Herein, we present a case of a pulmonary sarcomatoid carcinoma patient with epiglottis and ileum metastasis detected by 18F-FDG PET/CT. Lymphoma or multiple primary cancers with or without regional node metastasis were suspected. Ultimately, histopathology after biopsy revealed pulmonary sarcomatoid carcinoma with epiglottic and ileum metastases. Our case highlights the unique advantages of 18F-FDG PET/CT in searching for the unsuspected metastasis.

Detection rate of fluorine-18 prostate-specific membrane antigen-1007 PET/CT for prostate cancer in primary staging and biochemical recurrence with different serum PSA levels: A systematic review and meta-analysis.

Background: We performed a systematic review and meta-analysis to evaluate the detection rate (DR) of fluoro-prostate-specific membrane antigen (18F-PSMA-1007) PET/CT in patients with different serum prostate-specific antigen (PSA) levels in the setting of primary staging of prostate cancer (PCa) or biochemically recurring PCa. Methods: A comprehensive electronic literature search of the PubMed, Embase, and Cochrane Library databases was conducted in accordance with the PRISMA statement. This study was registered in the PROSPERO database (registration number: CRD42022331595). We calculated the DR of 18F-PSMA-1007 PET/CT in PCa. Results: The final analysis included 15 studies that described 1,022 patients and 2,034 lesions with 18F-PSMA-1007 PET/CT in PCa. The DR of 18F-PSMA-1007 PET/CT in patients with PCa in primary staging ranged from 90% to 100%, with a pooled estimate of 94% (95% CI: 92%-96%). The DR of 18F-PSMA-1007 PET/CT in patients with PCa in BCR ranged from 47% to 100%, with a pooled estimate of 86% (95% CI: 76%-95%). The DRs of PSA levels >2.0, 1.1-2.0, 0.51-1.0, and ≤0.5 ng/ml detected by 18F-PSMA-1007 PET/CT in a patient-based analysis were 97% (95% CI: 93%-99%), 95% (95% CI: 88%-99%), 79% (95% CI: 68%-88%), and 68% (95% CI: 58%-78%), respectively. Conclusion: This meta-analysis concluded that 18F-PSMA-1007 PET/CT had a high application value for prostate cancer, including primary tumors and biochemical recurrence. The DR of 18F-PSMA-1007 PET/CT was slightly higher in primary prostate tumors than in biochemical recurrence. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022331595.

Enlarged perivascular spaces and white matter hyperintensities in patients with frontotemporal lobar degeneration syndromes.

Objective: The aim of this study was to investigate the distribution characteristics of enlarged perivascular spaces (EPVS) and white matter hyperintensities (WMH) and their associations with disease severity across the frontotemporal lobar degeneration (FTLD) syndromes spectrum. Methods: This study included 73 controls, 39 progressive supranuclear palsy Richardson's syndrome (PSP-RS), 31 corticobasal syndrome (CBS), 47 behavioral variant frontotemporal dementia (bvFTD), 36 non-fluent variant primary progressive aphasia (nfvPPA), and 50 semantic variant primary progressive aphasia (svPPA). All subjects had brain magnetic resonance imaging (MRI) and neuropsychological tests, including progressive supranuclear palsy rating scale (PSPRS) and FTLD modified clinical dementia rating sum of boxes (FTLD-CDR). EPVS number and grade were rated on MRI in the centrum semiovale (CSO-EPVS), basal ganglia (BG-EPVS), and brain stem (BS-EPVS). Periventricular (PWMH) and deep (DWMH) were also graded on MRI. The distribution characteristics of EPVS and WMH were compared between control and disease groups. Multivariable linear regression analysis was performed to evaluate the association of EPVS and WMH with disease severity. Results: Compared with control subjects, PSP-RS and CBS had more BS-EPVS; CBS, bvFTD, and nfvPPA had less CSO-EPVS; all disease groups except CBS had higher PWMH (p < 0.05). BS-EPVS was associated with PSPRS in PSP-RS (ß = 2.395, 95% CI 0.888-3.901) and CBS (ß = 3.115, 95% CI 1.584-4.647). PWMH was associated with FTLD-CDR in bvFTD (ß = 1.823, 95% CI 0.752-2.895), nfvPPA (ß = 0.971, 95% CI 0.030-1.912), and svPPA (OR: 1.330, 95% CI 0.457-2.204). Conclusion: BS-EPVS could be a promising indicator of disease severity in PSP-RS and CBS, while PWMH could reflect the severity of bvFTD, nfvPPA, and svPPA.

Associations of MRI-visible perivascular spaces with longitudinal cognitive decline across the Alzheimer's disease spectrum.

OBJECTIVE: To investigate the characteristics and associations of MRI-visible perivascular spaces (PVS) with clinical progression and longitudinal cognitive decline across the Alzheimer's disease spectrum. METHODS: We included 1429 participants (641 [44.86%] female) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. PVS number and grade in the centrum semiovale (CSO-PVS), basal ganglia (BG-PVS), and hippocampus (HP-PVS) were compared among the control (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD) groups. PVS were tested as predictors of diagnostic progression (i.e., CN to MCI/AD or MCI to AD) and longitudinal changes in the 13-item Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog 13), Mini-Mental State Examination (MMSE), memory (ADNI-MEM), and executive function (ADNI-EF) using multiple linear regression, linear mixed-effects, and Cox proportional hazards modeling. RESULTS: Compared with CN subjects, MCI and AD subjects had more CSO-PVS, both in number (p < 0.001) and grade (p < 0.001). However, there was no significant difference in BG-PVS and HP-PVS across the AD spectrum (p > 0.05). Individuals with moderate and frequent/severe CSO-PVS had a higher diagnostic conversion risk than individuals with no/mild CSO-PVS (log-rank p < 0.001 for all) in the combined CN and MCI group. Further Cox regression analyses revealed that moderate and frequent/severe CSO-PVS were associated with a higher risk of diagnostic conversion (HR = 2.007, 95% CI = 1.382-2.914, p < 0.001; HR = 2.676, 95% CI = 1.830-3.911, p < 0.001, respectively). A higher CSO-PVS number was associated with baseline cognitive performance and longitudinal cognitive decline in all cognitive tests (p < 0.05 for all). CONCLUSIONS: CSO-PVS were more common in MCI and AD and were associated with cognitive decline across the AD spectrum.

MRI-Visible Perivascular Spaces Associated With Cognitive Impairment in Military Veterans With Traumatic Brain Injury Mediated by CSF P-Tau.

Objective: To investigate the association of MRI-visible perivascular spaces (PVS) with cognitive impairment in military veterans with traumatic brain injury (TBI), and whether cerebrospinal fluid (CSF) p-tau and Aß mediate this effect. Materials and Methods: We included 55 Vietnam War veterans with a history of TBI and 52 non-TBI Vietnam War veterans from the Department of Defense Alzheimer's Disease Neuroimaging Initiative (ADNI) database. All the subjects had brain MRI, CSF p-tau, Aß, and neuropsychological examinations. MRI-visible PVS number and grade were rated on MRI in the centrum semiovale (CSO-PVS) and basal ganglia (BG-PVS). Multiple linear regression was performed to assess the association between MRI-visible PVS and cognitive impairment and the interaction effect of TBI. Additionally, mediation effect of CSF biomarkers on the relationship between MRI-visible PVS and cognitive impairment was explored in TBI group. Results: Compared with military control, TBI group had higher CSO-PVS number (p = 0.001), CSF p-tau (p = 0.022) and poorer performance in verbal memory (p = 0.022). High CSO-PVS number was associated with poor verbal memory in TBI group (ß = -0.039, 95% CI -0.062, -0.016), but not in military control group (ß = 0.019, 95% CI -0.004, 0.043) (p-interaction = 0.003). Further mediation analysis revealed that CSF p-tau had a significant indirect effect (ß = -0.009, 95% CI: -0.022 -0.001, p = 0.001) and mediated 18.75% effect for the relationship between CSO-PVS and verbal memory in TBI group. Conclusion: MRI-visible CSO-PVS was more common in Vietnam War veterans with a history of TBI and was associated with poor verbal memory, mediated partially by CSF p-tau.

Diagnostic value of a vision-based intelligent gait analyzer in screening for gait abnormalities.

BACKGROUND: Early detection of gait abnormalities is critical for preventing severe injuries in future falls. The timed up and go (TUG) test is a commonly used clinical gait screening test; however, the interpretation of its results is limited to the TUG total time. RESEARCH QUESTION: What is diagnostic accuracy of the low-cost, markerless, automated gait analyzer, with the aid of vision-based artificial intelligence technology, which extract gait spatiotemporal features and screen for abnormal walking patterns through video recordings of the TUG test? METHODS: Our dataset contained retrospective data from outpatients from the Department of Neurology or Rehabilitation of two tertiary hospitals in Shanghai. A panel of three expert neurologists specialized in movement disorders reviewed the gait performance in each TUG video, and labeled them separately, with the most commonly assigned label being used as the reference standard. The gait analyzer performed the AlphaPose algorithm to track the human joint position and calculated the spatiotemporal parameters by filtering and double-threshold signal detection. Gait spatiotemporal features and expert labels were input into machine learning models, and the accuracy of each model was tested with leave-one-out cross-validation (LOOCV). RESULTS: A total of 284 participants were recruited. Among these, 100 were labeled as having abnormal gait performance by experts. The Naive Bayes classifier achieved the best performance with a full-data accuracy of 90.14% and a LOOCV accuracy of 89.08% for screening abnormal gait performance. SIGNIFICANCE: This study is the first to investigate the accuracy of a vision-based intelligent gait analyzer for screening abnormal clinical gait performance. By virtue of a pose estimation algorithm and machine learning models, our intelligent gait analyzer can detect abnormal walking patterns approximate to judgements made by experienced neurologists, which is expected to be a supplementary gait assessment protocol for basic-level doctors in the future.

A Probe into the Intervention Mechanism of Yiqi Huayu Jiedu Decoction on TLR4/NLRP3 Signal Pathway in Lipopolysaccharide-Induced Acute Respiratory Distress Syndrome (ARDS) Rats.

BACKGROUND: This study discusses the anti-inflammatory mechanism of Yiqi Huayu Jiedu decoction (YQHYJD) and studies the intervening effect of YQHYJD on the inflammatory cytokines in acute respiratory distress syndrome (ARDS) rats by inhibiting the TLR4/NLRP3 signal pathway. The aim of the probe is to provide evidence to support the identification of therapeutic targets in Chinese medicine treatment, which broadens the alternatives for the treatment of ARDS. METHOD: A lipopolysaccharide (LPS)-induced ARDS model group is established on rats by tail vein injection. A medicine group is established on ARDS rats by prophylactic administration using YQHYJD. Materials are collected, and tests are conducted according to experimental processes. RESULT: The rats in the medicine group gained weight compared with those in the ARDS model group. Pathological sections from the medicine group indicated improved condition in terms of pulmonary and interstitial edema in the lung tissues of rats compared with that from the ARDS model group. The percentage of neutrophil of the medicine group was significantly brought down compared with that of the ARDS model group (P < 0.001). Enzyme-linked immunosorbent assay (ELISA) was used to detect the changes in the level of inflammatory cytokines. It was observed that the levels of IL-1ß and IL-18 in serum of the medicine group significantly decreased (P < 0.001 and P < 0.01), the contents of TLR4 and NLRP3 in bronchoalveolar lavage fluid (BALF) of the medicine group decreased, and the contents of TLR4 and NLRP3 in lung tissue homogenate of the medicine group significantly decreased (P < 0.05, P < 0.001, P < 0.01, and P < 0.05). In further mass spectrum identification of the proteins from the same animal groups, it was observed that the expressions of inflammatory proteins TNFRSF1, LBP, and NOS2 of the medicine group were reduced. The differences were statistically significant. CONCLUSIONS: The pharmacological action of YQHYJD's anti-inflammatory mechanism is closely associated with the regulation of inflammatory cytokines TLR4, NLRP3, IL-1ß, IL-18, TNFRSF1, LBP, and NOS2 on the TLR4/NLRP3 signal pathway.